Form SB III
(See regulation 3)
BILL FOR EXPORT FOR GOODS

Original
 

SB No. & Date Customs Station Code IEC Code [GSTIN/UIN/PAN
etc. as applicable]
 

 

 

 

Exporter Name & Address

Buyer Name & Address

Consignee (if different from Buyer)

Customs Broker & License No.

 

Lorry No./Goods Train & Wagon No.

Originating From

 

Place of Delivery

Land Customs Station

Others (specify)

Foreign Exchange Details:

Authorized Dealer Code

RBI Waiver No. & Date, if any

 

 

Commercial Invoice Details: [To be provided separately for each Invoice]

Commercial Invoice Nos. & date

Invoice Value

Currency of Invoice

Exchange Rate U/S 14 of Customs Act

Total Value ( in Rupees)

 INCOTERM

Analysis of Export Value                 Currency                    Amount

vii. FOB
viii. Freight
ix. Insurance
x. Commission
xi. Discount
xii. Other Deductions

 
Nature of Payment

 

Cargo Details: [To be provided separately for each Invoice]

Nature of Cargo

Gross Weight

Net Weight

No. and kind of packages

Marks & Nos.

 

 

Item Level Details at Invoice level: [To be provided separately for each Invoice]

Sl. No.

Description of goods

Quantity Code

Quantity

Unit Value

Total value of Item

 

 

 

 

 

 

Total

-

-

 

-

 

 

Item Level Details for the Shipping Bill:

Sl. No.

Marks & Nos.

No. and kind of packages

Description of Goods

UQC

Qu ant ity

Unit Value

Total Value

PMV (Where applicable)

Statistical Code

Scheme Code

 

 

 

 

 

 

 

 

 

 

 

Total

-

 

-

-

 

-

 

-

-

-

 

Export duty related details, if any:

Sl. No.

Custo ms Tariff Head

Assessable Value                 under Sec. 14 of CA

Export Duty

Cess

Total Export Duty & Cess Amount (In

numbers & words)

Duty payment particulars

Ra te

Amount

Rate

Amount

 

IGST Details:

Whether supply meant for export on payment of IGST (Y/N)

Total amount of IGST paid, if applicable

Whether supply meant for export under bond or letter of undertaking without payment of IGST (Y/N)

Details of Bond or LUT

Total     Value    of Supply of Goods

Taxable value of supply of goods

 

 

 

Invoice Nos. & Date (Issued under GST Tax Invoice, Credit &

Debit Notes

Rules 2017)

Item Sr.

No.

 

 

CTH

 

 

Goods description

 

 

Value of Supply of Goods

 

 

Whether IGST Paid(Y/N)

 

 

Whether Compensation Cess Paid (Y/N)

Rate at which IGST Paid

 

 

Rate at which Compensation Cess Paid

Amount of IGST

Paid

 

Amount         of Compensation Cess

Paid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Export Scheme/Job Work/Re-export Details:

A. EPCG Scheme [Scheme Code]:

Item Sl. No. in the shipping Bill

Whether Export is third party Export

IEC[GSTIN/UIN/PAN etc] of manufacturer in case of ‘third Party Export’

Authorization No. and Date

Sl. No. of Export item as per the Export Item list in the Authorization

 

 

 

 

 

 

 

 

 

 

 

B. Advance Authorisation/DFIA [Scheme Code] [details of inputs used for the manufacture of export goods]:

Item Sl. No. in the shipping Bill

Authorization No. and Date

Description of the Export goods and the Sl. No. in the Authorization

Export Quantity

Name and Description of the inputs consumed in the manufacturing of Export  goods and the Sl. No. in the Authorization

Quantity of the inputs consumed

Whether imported or indigenous

SION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Export of Goods in anticipation of issue of an Advance Authorisation:

Item Sl. No. in the shipping Bill

Description of the Export goods

Export Quantity

Name and Description of the inputs consumed in the manufacturing of Export goods

Quantity of the inputs consumed

SION

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Job Work Details:[details in relation to import goods worked upon during job work]

B/E No. & Date

Customs Station Code of Import

Description Of goods imported

Quantity Imported

Quantity consumed in export goods

Bond & BG details

Value Addition in percentage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Exports under claim of drawback under section 74:

Item Sl.No. in the Shipping Bill

Bill of Entry No. and date

Sl. No. of the goods in the Bill of Entry

Description of goods as per the Bill of Entry

Marks and Identification numbers at the time of import

Whether imported goods used(Y/N)

Date of payment/debit of duty on importation

Duty paid at the time of importation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Container Details:[If export cargo is factory stuffed cargo]

Sl No.

Type of Container

Size of Container

Container No.

Seal No.

 

 

 

 

 

 

 

 

 

 

 

Declaration :

I/We declare that all particulars given herein are true and correct. I/We intend to claim rewards under MEIS.
I/We also attach the declaration(s) under clause No.(s)…

Public Notice No. Dated……

Signature of Exporter/CB & Date
 

 

BILL OF EXPORT FOR GOODS

Original

DOCUMENTS SUBMITTED
1. Invoice [ ]
2. Packing List [ ]
3. Export License [ ]
4. Indent [ ]
5. Acceptance of Contract [ ]
6. Letter of Credit [ ]
7. QC Certificate [ ]
8. Any other (Specify) [ ]

SB III
(See regulation 3)
BILL FOR EXPORT FOR GOODS

Duplicate

 

SB No. & Date

 

Customs Station Code

 

IEC Code [GSTIN/UIN/PAN etc. as applicable]

Exporter Name & Address

Buyer Name & Address Consignee (if different from Buyer)

Customs Broker & License No.

 

Lorry No./Goods Train & Wagon No.

Originating From

 

Place of Delivery

Land Customs Station

 

 

 

 

Others (specify)

Foreign Exchange Details:

Authorized Dealer Code

RBI Waiver No. & Date, if any

 

 

Commercial Invoice Details: [To be provided separately for each Invoice]

Commercial Invoice Nos. & date

Invoice Value

Currency of Invoice

Exchange Rate U/S 14 of Customs Act

Total Value ( in Rupees)

 INCOTERM

Analysis of Export Value                 Currency                    Amount

 
 i. FOB
ii. Freight
iii. Insurance
iv. Commission
v. Discount
vi. Other Deductions
 
Nature of Payment
   

Cargo Details: [To be provided separately for each Invoice]

Nature of Cargo

Gross Weight

Net Weight

No. and kind of packages

Marks & Nos.

 

 

Item Level Details at Invoice level: [To be provided separately for each Invoice]

Sl. No.

Description of goods

Quantity Code

Quantity

Unit Value

Total value of Item

 

 

 

 

 

 

Total

-

-

 

-

 

 

Item Level Details for the Shipping Bill:

Sl. No.

Marks & Nos

.

No. and kind of packages

Description of Goods

UQC

Quantity

UnitValue

Total Value

PMV(Where applicable)

Statistical Code

Scheme Code

 

 

 

 

 

 

 

 

 

 

 

Total

 

-

 

-

-

 

-

 

-

-

-

 

Export duty related details, if any:

Sl. No.

Customs Tariff Head

Assessable Value                 under Sec. 14 of CA

Export Duty

Cess

Total Export Duty & Cess Amount (In

numbers          & words)

Duty              payment particulars

Rate

Amount

Rate

Amount

 

 

 

IGST Details:

Whether supply meant for export on payment of IGST (Y/N)

Total amount of IGST paid, if applicable

Whether supply meant for export under bond or letter of undertaking without payment of IGST (Y/N)

Details of Bond or LUT

Total Value of Supply of Goods

Taxable value of supply of goods

 

 

 
Invoice Nos. & Date (Issued under GST Tax Invoice, Credit & Debit Notes Rules 2017) Item Sr. No. CTH Goods descript ion Value of Supply of Goods Whether IGST Paid (Y/N) Whether Compensation Cess Paid (Y/N) Rate at which IGST Paid Rate at which Compensation Cess Paid Amount of IGST Paid Amount of Compensation Cess Paid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Export Scheme/Job Work/Re-export Details:

A. EPCG Scheme [Scheme Code]:
Item Sl. No. in the shipping Bill Whether Export is third party Export IEC[GSTIN/ UIN/PAN etc] of manufacturer in case of ‘third Party Export’ Authorization No. and Date Sl. No. of Export item as per the Export Item list in the Authorization

 

 

 

 

 

 

 

 

 

 

 

B. Advance Authorisation/DFIA [Scheme Code] [details of inputs used for the manufacture of export goods]:

Item Sl. No. in the shipping Bill

Authorization No. and Date

Description of the Export goods and the Sl. No. in the Authorization

Export Quantity

Name and Description of the inputs consumed in the manufacturing of Export goods and the Sl. No. in the Authorization

Quantity of the inputs consumed

Whether imported or indigenous

SION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Export of Goods in anticipation of issue of an Advance Authorisation:

Item Sl. No. in the shipping Bill

Description of the Export goods

Export Quantity

Name and Description of the inputs consumed in the manufacturing of Export goods

Quantity of the inputs consumed

SION

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Job Work Details:[details in relation to import goods worked upon during job work]

B/E No. & Date

Custo ms Station Code of import

Description

 

Of goods imported

Quantity Imported

Quantity consumed in export goods

Bond & BG details

Value Addition in percentage
             
             
             

E. Exports under claim of drawback under section 74:

Item Sl.No. in the Shipping Bill

Bill of Entry No. and date

Sl. No. of the goods in the Bill of Entry

Description of goods as per the Bill of Entry

Marks and Identification numbers at the time of import

Whether imported goods used(Y/N)

Date of payment/debit of duty on importation

Duty paid at the time of importation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Container Details:[If export cargo is factory stuffed cargo]

Sl No.

Type of Container

Size of Container

Container No.

Seal No.

 

 

 

 

 

 

 

 

 

 

 

Declaration :

 

I/We declare that all particulars given herein are true and correct. I/We intend to claim rewards under MEIS.

I/We also attach the declaration(s) under clause No.(s)…

 

Public Notice No. ……………………….Dated……                   Signature of Exporter/CB & Date

BILL OF EXPORT FOR GOODS

Duplicate

I/We  claim  drawback  of Rs. …………

under Sec. 74/75 of Customs Act, 1962 and Customs, Central Excise Duties and Service Tax Drawback Rules, 1995/ Customs and Central Excise Duties Drawback Rules, 2017. I/We certify that the export goods are new/used for …….

I/We certify that I/We have compled with the conditions laid down in the said Rules and the conditions subject to which Drawback Rates are applicable.

1.  Name and Address of Bank

2.  Account No.  

3. DBK Ledger No.

Documents Submitted

 1. Invoice [ ]
 
2. Packing List [ ]
 
3. Export License [ ]
 
4.Indent [ ]
 
5.Acceptance of Contract [ ]
 
6. Letter of Credit [ ]
 
7.QC Certificate [ ]
 
8.Any Other Document (specify) [ ]
 

Item No. in S/B

S.No. of Dbk Schedule

Qty./Wt. on which Dbk claimed

Value on which Dbk claimed

Rate of Dbk

Amount of Dbk

Total Dbk

Customs

Excise

Customs

Excise

 

 

 

 

 

 

 

 

 

Total Amount in words: Rupees …………………

 

Signature of Exporter/CB

‘LET EXPORT’

 

Signature of Officer of Customs

‘ALLOWED FOR DESPATCH’

 

 

Signature of Officer of Customs
Carrier’s name & Lorry No./Goods Train & Wagon No. may be Fee Rs. altered after check with original
Entry for
Fresh one may be granted to ……………………………...
 
for the portion shutout or not shipped
 
 
 
Received                                                          Handed over to CB./Party Signature of Asstt. Commissoner of Customs Cashier
 
Contents Received on Board

 Date                                                     For Carrier

 Date of Shipment

Signature of Officer of Customs
Examination Order and Report

SB III
(See regulation 3)
BILL FOR EXPORT FOR GOODS

Triplicate
 

 

SB No. & Date

 

Customs Station Code

 

IEC Code [GSTIN/UIN/PAN etc. as applicable]

Exporter Name & Address

Buyer Name & Address 

Consignee (if different from Buyer)

Customs Broker & License No.

 

Lorry No./Goods Train & Wagon No.

Originating From

 

Place of Delivery

Land Customs Station 

Others (specify)

Foreign Exchange Details:

Authorized Dealer Code

RBI Waiver No. & Date, if any

 

 

Commercial Invoice Details: [To be provided separately for each Invoice]

Commercial Invoice Nos. & date

Invoice Value

Currency of Invoice

Exchange Rate U/S 14 of Customs Act

Total Value ( in Rupees)

 INCOTERM

Analysis of Export Value                 Currency                    Amount

i. FOB
ii. Freight
iii. Insurance
iv. Commission
v. Discount
vi. Other Deductions

Nature of Payment
 

Cargo Details: [To be provided separately for each Invoice]

Nature of Cargo

Gross Weight

Net Weight

No. and kind of packages

Marks & Nos.

 

 

Item Level Details at Invoice level: [To be provided separately for each Invoice]

Sl. No.

Description of goods

Quantity Code

Quantity

Unit Value

Total value of Item

 

 

 

 

 

 

Total

-

-

 

-

 

 

Item Level Details for the Shipping Bill:

Sl. No.

Marks & No s.

No. and kind of packages

Description of Goods

UQC

Quantity

Unit Value

Total Value

PMV

(Where applicable)

Statistical Code

Scheme Code
                     
                     

Total

-

 

-

-

 

-

 

-

-

-

 

Export duty related details, if any:

Sl. No.

Customs Tariff Head

Assessable Value                under Sec. 14 of CA

Export Duty

Cess

Total Export Duty & Cess Amount (In

numbers & words)

Duty      payment particulars

Rate

Amount

Rate

Amount

 

IGST Details:

Whether supply meant for export on payment of IGST (Y/N)

Total amount of IGST paid, if applicable

Whether supply meant for export under bond or letter of undertaking without payment of IGST (Y/N)

Details of Bond or LUT

Total    Value   of Supply of Goods

Taxable value of supply of goods

 

 

 

Invoice Nos. & Date (Issued under GST Tax Invoice, Credit & Debit

Notes Rules 2017)

Item Sr.No.

CTH

Goods description

Value of Supply of Goods

Whether IGST

Paid (Y/N)

Whether Compensation Cess Paid (Y/N)

Rate at which IGSTPaid

Rate at which Compensation Cess Paid

Amount of IGST Paid

Amount         of Compensation Cess Paid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Export Scheme/Job Work/Re-export Details:

A. EPCG Scheme [Scheme Code]:

Item Sl. No. in the shipping Bill

Whether Export is third party Export

IEC[GSTIN/ UIN/PAN

etc] of manufacturer in case of ‘third Party Export’

Authorization No. and Date

Sl. No. of Export item as per the Export Item list in the Authorization

 

 

 

 

 

 

 

 

 

 

 

B. Advance Authorisation/DFIA [Scheme Code] [details of inputs used for the manufacture of export goods]:

Item Sl. No. in the shipping Bill

Authorization No. and Date

Description of the Export goods      and the Sl. No. in the Authorization

Exp ort Quantity

Name and Description of the inputs consumed in the manufacturing of Export goods and the Sl. No. in the Authorization

Quantity of the inputs consumed

Whether imported or indigenous

SION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Export of Goods in anticipation of issue of an Advance Authorisation:
Item Sl. No. in the shipping Bill Description of the Export goods Export Quantity Name and Description of the inputs consumed in the manufacturing of Export goods Quantity of the inputs consumed SION

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Job Work Details:[details in relation to import goods worked upon during job work]

B/E No. & Date

Customs Station Code of Import

Description Of goods imported

Quantity Imported

Quantity consumed in export goods

Bond & BG details

Value Addition in percentage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Exports under claim of drawback under section 74:
Item Sl.No. in the Shipping Bill Bill of Entry No. and date Sl. No. of the goods in the Bill of Entry Description of goods as per the Bill of Entry Marks and Identification numbers at the time of import Whether imported goods used(Y/N) Date of payment/debit of duty on importation Duty paid at the time of importation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Container Details:[If export cargo is factory stuffed cargo]

Sl No.

Type of Container

Size of Container

Container No.

Seal No.

 

 

 

 

 

 

 

 

 

 

 

Declaration :

 

I/We declare that all particulars given herein are true and correct. I/We intend to claim rewards under MEIS.

I/We also attach the declaration(s) under clause No.(s)…

 

Public Notice No. ……………………….Dated……                   Signature of Exporter/CB & Date

BILL OF EXPORT FOR GOODS

Triplicate

I/We claim drawback of Rs. …………
under Sec. 74/75 of Customs Act, 1962 and Customs, Central Excise Duties and Service Tax Drawback Rules, 1995/ Customs and Central Excise Duties Drawback Rules, 2017. I/We certify that the export goods are new/used for …….
I/We certify that I/We have compled with the conditions laid down in the said Rules and the conditions subject to which Drawback Rates are applicable.

1. Name and Address of Bank

2. Account No. 3. DBK Ledger No.
 

Documents Submitted

1. Invoice [ ]
 
2. Packing List [ ]
 
3. Export License [ ]
 
4.Indent [ ]
 
5.Acceptance of Contract [ ]
 
6. Letter of Credit [ ]
 
7.QC Certificate [ ]
 
8.Any Other Document (specify) [ ]
 

 

Item

 

Qty./Wt. on

Value on which

Rate of Dbk

Amount of Dbk

Total Dbk

No. in S/B

S.No. of Dbk Schedule

which Dbk claimed

Dbk claimed

Customs

Excise

Customs

Excise

 

 

 

 

 

 

 

 

 

Total Amount in words: Rupees …………………

  

 

Signature of Exporter/CB

FOR DEPARTMENT OFFICER

Verified that the amount of DBK as claimed above is admissible subject to description found correct on the basis of physical examination/test etc.

 

 

 

Signature of A.O. & Stamp

 

Calculation Checked.

 

 

 

 

 

 Comptist

PRE-RECEIPT FORM

Received the sum of Rs.

…………………………………………... as drawback

 

 

REVENUE STAMP

 

Signature of Exporter/CB

‘LET EXPORT’

  

Signature of Officer of Customs

‘ALLOWED FOR DESPATCH’

  

Signature of Officer of Customs
Claim Pre-audited for Sanction                                             Claimed passed for Rs…………… Inspector(Audit) Supdt./AC Claim Registration No………..Issued Cheque No………..Dated…………. For Rs. ……………………………….(Rupees…………………………….)

Dealing Clerk                   Officer

 
Examination Order and Report

 

SB III
(See regulation 3)
BILL FOR EXPORT FOR GOODS
(EXPORT PROMOTION COPY)

Quadruplicate

 SB No. & Date

 Customs Station Code

 IEC Code [GSTIN/UIN/PAN etc. as applicable]
Exporter Name & Address

Buyer Name & Address 

Consignee (if different from Buyer)

 

 Customs Broker & License No.

 

  

 

Lorry No./Goods Train & Wagon No.

Originating From

 

Place of Delivery

Land Customs Station

  Others (specify)

Foreign Exchange Details:

Authorized Dealer Code

RBI Waiver No. & Date, if any

 

 

Commercial Invoice Details: [To be provided separately for each Invoice]

Commercial Invoice Nos. & date

Invoice Value

Currency of Invoice

Exchange Rate U/S 14 of Customs Act

Total Value ( in Rupees)

 INCOTERM

Analysis of Export Value                 Currency                    Amount

 
 
vii. FOB
viii. Freight
ix. Insurance
x. Commission
xi. Discount
xii. Other Deductions
 

Nature of Payment
 

Cargo Details: [To be provided separately for each Invoice]

Nature of Cargo

Gross Weight

Net Weight

No. and kind of packages

Marks & Nos.

 

 

Item Level Details at Invoice level: [To be provided separately for each Invoice]

Sl. No.

Description of goods

Quantity Code

Quantity

Unit Value

Total value of Item

 

 

 

 

 

 

Total

-

-

 

-

 

 

Item Level Details for the Shipping Bill:

Sl. No.

Ma rks & No s.

No. and kind of packag es

Descri ption of Goods

UQC

Qua ntit y

Unit Value

Total Value

PMV

(Where applicable)

Statistical Code

Scheme Code

 

 

 

 

 

 

 

 

 

 

 

Total

-

 

-

-

 

-

 

-

-

-

 

Export duty related details, if any:

Sl. No.

Customs Tariff Head

Assessable Value                 under Sec. 14 of CA

Export Duty

Cess

Total Export Duty & Cess Amount (In

numbers & words)

Duty             payment particulars

Rate

Amount

Rate

Amount

 

 

 

IGST Details:

Whether supply meant for export on payment of IGST (Y/N)

Total amount of IGST paid, if applicable

Whether supply meant for export under bond or letter of undertaking without payment of IGST (Y/N)

Details of Bond or LUT

Total    Value    of Supply of Goods

Taxable value of supply of goods

 

 

 
 
Invoice
Nos. &
Date
(Issued under GST Tax Invoice, Credit & Debit Notes Rules 2017)
 		 Item Sr. No. CTH Goods descript ion Value of Supply of Goods Whether IGST Paid (Y/N) Whether Compensation Cess Paid (Y/N) Rate at which IGST Paid Rate at which Compensation Cess Paid Amount of IGST Paid Amount of Compensation Cess Paid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Export Scheme/Job Work/Re-export Details:

A. EPCG Scheme [Scheme Code]:
Item Sl. No. in the shipping Bill Whether Export is third party Export IEC[GSTIN/ UIN/PAN etc] of manufacturer in case of ‘third Party Export’ Authorization No. and Date Sl. No. of Export item as per the Export Item list in the Authorization

 

 

 

 

 

 

 

 

 

 
 

 B. Advance Authorisation/DFIA [Scheme Code] [details of inputs used for the manufacture of export goods]:
 
Item Sl. No. in the shipping Bill Authorization No. and Date Description of the Export goods and the Sl. No. in the Authorization Exp ort Quantity Name and Description of the inputs consumed in the manufacturing of Export goods and the Sl. No. in the Authorization Quantity of the inputs consumed Whether imported or indigenous SION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Export of Goods in anticipation of issue of an Advance Authorisation:

Item Sl. No. in the shipping Bill

Description of the Export goods

Export Quantity

Name and Description of the inputs consumed in the manufacturing of Export goods

Quantity of the inputs consumed

SION

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Job Work Details:[details in relation to import goods worked upon during job work]

B/E No. & Date

Customs Station Code of Import

Description Of goods imported

Quantity Imported

Quantity consumed in export goods

Bond & BG details

Value Addition in percentage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Exports under claim of drawback under section 74:
Item Sl.No. in the Shipping Bill Bill of Entry No. and date Sl. No. of the goods in the Bill of Entry Description of goods as per the Bill of Entry Marks and Identification numbers at the time of import Whether imported goods used(Y/N) Date of payment/debit of duty on importation Duty paid at the time of importation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Container Details:[If export cargo is factory stuffed cargo]

Sl No.

Type of Container

Size of Container

Container No.

Seal No.

 

 

 

 

 

 

 

 

 

 

 

Declaration :

 

I/We declare that all particulars given herein are true and correct. I/We intend to claim rewards under MEIS.

I/We also attach the declaration(s) under clause No.(s)…

 

Public Notice No. ……………………….Dated……                   Signature of Exporter/CB & Date

BILL OF EXPORT FOR GOODS
(EXPORT PROMOTION COPY)

Quadruplicate

Verified Railway Receipt No../Lorry Waybill No. ………………………….Dated……………….

of ………………………………………………………………………...…………………………

issued by
For..……………….Cases/Bales/Packages/Containers………………………………………………………
………………………………………………………………….………………………………….Despatched per… which left
on…………………………………………………………………………………………

From……………………………………………………………………………………………………

Under Preventive Supervision

Signature of Officer of Customs